Skyrizi (Risankizumab) Dosing for Moderate to Severe Plaque Psoriasis
For moderate to severe plaque psoriasis, administer Skyrizi 150 mg by subcutaneous injection at week 0, week 4, and every 12 weeks thereafter. 1
FDA-Approved Dosing Regimen
- Initial loading doses: 150 mg subcutaneously at week 0 and week 4 1
- Maintenance dosing: 150 mg subcutaneously every 12 weeks after the loading doses 1
- Route of administration: Subcutaneous injection that can be self-administered after proper training 1
Formulation Options
- Available as 150 mg/mL prefilled pen or prefilled syringe for single injection 1, 2
- The 150 mg/mL formulation allows for a single injection rather than multiple injections, improving patient convenience 2
- Both prefilled syringe and autoinjector devices demonstrate high usability and acceptability for self-administration 2
Administration Technique
- Allow the medication to reach room temperature before injection (30-90 minutes for prefilled pen, 15-30 minutes for prefilled syringe) 1
- Avoid injecting into areas where skin is tender, bruised, erythematous, indurated, or affected by psoriasis 1
- Upper outer arm administration should only be performed by a healthcare professional or caregiver 1
- If a dose is missed, administer as soon as possible and resume the regular 12-week schedule 1
Expected Clinical Outcomes
- Week 16 efficacy: 62.9-77% of patients achieve PASI 90 (≥90% improvement in psoriasis severity) 3, 2
- Week 16 clear/almost clear skin: 78.1-81.5% achieve static Physician's Global Assessment (sPGA) of 0 or 1 2
- Complete clearance: 45-54.2% achieve PASI 100 (complete clearance) by weeks 12-52 3, 4
- Long-term durability: Efficacy is maintained through 6 years of continuous treatment, with 86.0% achieving PASI 90 at week 304 4
Time to Response Assessment
- Assess definitive response (positive or negative) after 12 weeks of continuous therapy 3
- For partial responders at 12 weeks, consider adding topical corticosteroids, vitamin D analogues, methotrexate, or ultraviolet B light 3
- Although no published data support combination therapy with risankizumab, there is no reason to consider such combinations unsafe 3
Comparative Efficacy Context
Risankizumab demonstrates superior efficacy compared to other biologics in head-to-head trials. At week 12,77% of risankizumab-treated patients achieved PASI 90 compared to 40% with ustekinumab 3. The medication shows particularly high rates of complete clearance (PASI 100), with 45% achieving this outcome compared to 18% with ustekinumab 3.
Pre-Treatment Requirements
- Evaluate for tuberculosis infection before initiating treatment 1
- Complete all age-appropriate vaccinations per current immunization guidelines 1
- Use caution in patients with pre-existing immunosuppression-related conditions 3, 5
Safety Profile
Long-term safety data through 6 years (4,921.2 patient-years of exposure) demonstrate that rates of treatment-emergent adverse events, discontinuations due to adverse events, and adverse events of safety interest remain low and consistent with earlier studies 4. The medication is generally well tolerated in both short-term and long-term use 6.